![]() Provider grievances regarding payment, timely filing, or systemic or. Log on to Availity ® to request a claim review and initiate a negotiation (independent dispute resolution-IDR) for NSA-eligible services. The Blue Cross Blue Shield of Arizona (BCBSAZ) member dispute process covers both. If you do not have a contract with us, claims for certain services may be eligible for payment review under the No Surprises Act (NSA). Participating providers can contact your local Network Management office if you have any questions concerning the process for claim reviews. Mail the completed Claim Review form, along with any attachments, to the appropriate address indicated on the form. Primary carrier's EOB indicating claim was filed with the primary carrier within the timely filing deadline.Documentation from BCBSTX requesting additional information.Documentation from BCBSTX indicating claim was incomplete How long do I have to file a claim If you need to submit a claim, please mail it in time to be received by Blue Cross NC within 18 months after the service.Above documentation indicating that the claim was filed with the wrong division of Blue Cross and Blue Shield of Texas.rEDI-link Blue Claim Acceptance Response Report.Certified Mail Receipt (only if accompanied by TDI mail log).The claim review process for a specific claim will be considered complete following your receipt of the second claim review determination.įor those claims which are being reviewed for timely filing, BCBSTX will accept the following documentation as acceptable proof of timely filing: BCBSTX will complete the second claim review within 30 days following the receipt of your request for a second claim review.The second claim review must be requested within 15 days following your receipt of the first claim review determination. If the claim review determination is not satisfactory to you, you may request a second claim review. You will receive written notification of the claim review determination.BCBSTX will complete the first claim review within 45 days following the receipt of your request for a first claim review.
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